Family medicine
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Family medicine is the primary care medical specialty which "provides continuing, comprehensive health care for the individual and family... The scope of family medicine encompasses all ages, both sexes, each organ system, and every disease entity."[1]
Family medicine doctors in the United States may hold either an M.D. or a D.O. degree. Physicians who specialize in family medicine (also known as family physicians) must complete a three-year family medicine residency in addition to their medical degree, and are eligible for the board certification now required by most hospitals and health plans. [2]
The term "family medicine" is used in many European countries instead of "general medicine" or "general practice". In Sweden, certification in family medicine needs five years working with tutor, after the medical degree. Similar systems have been implemented in other countries.
Most family physicians practice in solo or small-group private practices or as hospital employees in practices of similar sizes owned by hospitals. However, the specialty is broad and allows for a variety of career options including education, emergency medicine or urgent care, inpatient medicine, international or wilderness medicine, public health, sports medicine, and research.[3] Others choose to practice as consultants to various medical institutions, including insurance companies.
[edit] Family medicine in USA
Following World War II, two events shaped the advent of family medicine. First, medical specialties and subspecialties increased in popularity, having an adverse affect on the number of physicians in general practice. At the same time, many medical advances were being made and there was concern within the "general practitioner" or "GP" population that four years of medical school plus a one-year internship was no longer adequate preparation for the breadth of medical knowledge required of the profession. [4] Many of these doctors wanted to see a residency program added to their training; this would not only give them additional training, knowledge, and prestige, but would allow for board certification, which was increasingly required to gain hospital privileges. [5] In 1969, family medicine (then known as family practice) was recognized as a distinct specialty in the U.S.[6]
Family physicians complete undergraduate school, medical school, and three more years of specialized medical residency training in family medicine. [7] Their residency training includes rotations in internal medicine, pediatrics, obstetrics-gynecology, psychiatry, and geriatrics. [8] The specialty focuses on treating the whole person--acknowledging the effects of all outside influences-- through all life stages. [9] Family physicians will see anyone with any problem, but are experts in common problems. Many family physicians deliver babies in addition to taking care of patients of all ages.
In order to become board certified, family physicians must complete a residency in family medicine, possess a full and unrestricted medical license, and take a written cognitive examination. [10] Between 2003 and 2009, the process for maintenance of board certification in family medicine is being changed (as well as all other American Specialty Boards) to a series of yearly tests on differing areas. The American Board of Family Medicine, as well as other specialty boards, are requiring additional participation in continuous learning and self-assessment to enhance clinical knowledge, expertise and skills. The Board has created a program called the "Maintenance of Certification Program for Family Physicians" (MC-FP) which will require family physicians to continuously demonstrate proficiency in four areas of clinical practice: professionalism, self assessment/lifelong learning, cognitive expertise, and performance in practice. Three hundred hours of continuing medical education within the prior six years is also required to be eligible to sit for the exam. [11]
Family physicians may pursue fellowships in diverse topics including adolescent medicine, geriatric medicine, sports medicine, sleep medicine, and hospice and palliative medicine. [12] The American Board of Family Medicine offers Certificates of Added Qualifications (CAQs) in each of these topics. [13]
The family medicine (FM) paradigm is bolstered by primary care physicians trained in internal medicine (IM); although these physicians are trained in internal medicine only, adult patients provide the majority of the patient base of many family medicine practices. In the United States, there is a rising contingent of physicians dually trained in internal medicine and pediatrics, which can be completed in four years, instead of the three years each for IM and pediatrics. A significant number of family medicine practices (especially in suburban and urban areas) do not provide obstetric services anymore (due to litigation issues and provider preference), and as such, this blurs the line between the FM and IM/Peds difference. One suggested difference is that the IM/Peds-trained physicians are more geared towards subspecialty training or hospital-based practice. Even so, there are groups with FM-trained and IM/Peds-trained physicians working in seamless harmony.
While many sources cite a shortage of family physicians (and also other primary care providers, i.e. internists, pediatricians, and general practitioners)[14], the per capita supply of primary care physicians has actually increased about 1 percent per year since 1998.[15] Additionally, a recent decrease in the number of M.D. graduates pursuing a residency in primary care, has been offset by the number of D.O graduates and graduates of international medical schools (IMGs) who enter primary care residencies.[16] Still, projections indicate that by 2020 the demand for family physicians will exceed their supply. [17]
The waning interest in family medicine is likely due to several factors, including the lesser prestige associated with the young specialty, the lesser pay, and the increasingly frustrating practice environment in the U.S. Salaries for family physicians in the United States are respectable, ranging from $150,000 to $204,000[18], but when faced with debt from medical school, medical students may opt for the higher paying specialties. Family physicians are trained to manage acute and chronic health issues for an individual simultaneously, yet their appointment slots may average only ten minutes.[19] Physicians are increasingly forced to do more administrative work, and to shoulder higher malpractice premiums, thus forcing doctors to spend less and less time with patient care due to the current payor model stressing patient volume vs. quality of care. Things are starting to change as more insurance carriers consolidate. They are not stressing performance but more and more volume, thus increasing insurance company profit margins. Physicians are starting to shun insurance carriers to lessen the paperwork in order to focus more on patient care as they are originally trained to do.
There is a current trend among family physicians to adopt a practice model called the micro practice, or "Ideal Medical Practice". These practices focus on reducing their overhead and increase their utilization of technology. Because the overhead is reduced, the need to see a high volume of patients to generate more revenue is diminished. This allows the doctor to spend more time with their patients, which results in higher satisfaction for the patient and the physician.
[edit] Family Medicine in Canada
Traditionally, family medical doctors perform specialized work in matters pertaining to reproduction or reproductive disorders. Doctors practicing outside of hospitals with clients are referred to as General Practitioners or GPs.
Doctors working in family medicine typically work in hospital departments. Working within an acute care setting the doctors work collaboratively as interdisciplinary teams associated with a number of services and programs to address patient care and clinical practice issues.
The clinical role of the doctor is to provide a full range of primary care services, including obstetrical care and newborn care, and provide inpatient palliative care and consultation. More specifically, the doctor provides comprehensive continuous care, disease prevention, and health promotion services including both general assessment and provision of preventive care and health promotion, diagnoses and treats acute and chronic health problems with appropriate specialty assistance, provides full reproductive and new born care, provides mental health care and appropriate supportive counseling, provides child health care, provides supportive in-hospital care, and, finally, continues to provide services for patients following their release from the hospital.
The doctor contributes to the discipline of family medicine by conducting appropriate, funded research and evaluation projects.
[edit] References
- ^ "Definitions and Policies", American Board of Family Medicine. Retrieved 6-30-2009.
- ^ "Choosing a Primary Care Provider", Medline Plus Medical Encyclopedia. Retrieved 6-30-09.
- ^ "Practice Options", Family Medicine Interest Group. Retrieved 6-30-09.
- ^ Pisacano, Nicholas J.. "History of the Specialty". American Board of Family Medicine. https://www.theabfm.org/about/history.aspx. Retrieved on 6-30-2009.
- ^ Pisacano, Nicholas J.. "History of the Specialty". American Board of Family Medicine. https://www.theabfm.org/about/history.aspx. Retrieved on 6-30-2009.
- ^ Pisacano, Nicholas J.. "History of the Specialty". American Board of Family Medicine. https://www.theabfm.org/about/history.aspx. Retrieved on 2007-08-08.
- ^ Adams, Bob. Primary Care. CQ Researcher, 5 (10), March 17, 1995.
- ^ "Patient Brochure", American Board of Family Medicine. Retrieved 6-30-09.
- ^ "The Future of Family Medicine: A Collaborative Project of the Family Medicine Community"(Mar-Apr, 2004), Annals of Family Medicine. Retrieved 6-30-09.
- ^ "Certification Policies", American Board of Family Medicine. Retrieved 6-30-09.
- ^ "Maintenance of Certification for Family Physicians (MC-FP)", American Board of Family Medicine. Retrieved 6-30-09.
- ^ "Fellowship Directory for Family Physicians", American Academy of Family Physicians. Retrieved 6-30-09.
- ^ "Certificates of Added Qualifications", American Board of Family Medicine. Retrieved 6-30-09.
- ^ Halsey, A. (2009, June 20). Primary-Care Doctor Shortage May Undermine Reform Efforts [Electronic version]. The Washington Post. Retrieved 6-30-09 from http://www.washingtonpost.com
- ^ U.S. General Accounting Office. (2008). Primary care professionals (electronic resource): recent supply trends, projection, and valuation of services. Testimony before the Committee on Health, Education, Labor, and Pensions, U.S. Senate. Retrieved 6-30-09 from http://www.gao.gov/new.items/d08472t.pdf
- ^ U.S. General Accounting Office. (2008). Primary care professionals (electronic resource): recent supply trends, projection, and valuation of services. Testimony before the Committee on Health, Education, Labor, and Pensions, U.S. Senate. Retrieved 6-30-09 from http://www.gao.gov/new.items/d08472t.pdf
- ^ U.S. General Accounting Office. (2008). Primary care professionals (electronic resource): recent supply trends, projection, and valuation of services. Testimony before the Committee on Health, Education, Labor, and Pensions, U.S. Senate. Retrieved 6-30-09 from http://www.gao.gov/new.items/d08472t.pdf
- ^ "2008 Physician compensation survey", Modern Healthcare. July 14, 2008. Retrieved 6-30-09.
- ^ Stange, K., Zyzanski, S. Jaen, C., Callahan, E., Kelly, R., Gillanders, W. et al. (1998). Illuminating the 'black box.' Journal of Family Practice, 46 (5), p. 377-389.
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